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a6f- <br />SAN JOAQUIN COUNTY <br />NOTIFICATION OF HAZARDOUS WASTE DISC-LARGE <br />HEALTH & SAFETY CODE 25180.7 <br />CoPY <br />A. EMERGENCY LEVEL: II In <br />(Circle One) <br />PHS-EH LOG # <br /> <br />3. SOURCE OF INFORMATION <br />Name: <br />Company: <br />Address: <br />Designated Employee Name: ?..-cm. Phone: -.t-)c-1) 4 (042:, - 0 <br />Reporting Agency Name:Sp4,1 TcAccui,d &vi t rykA6LciAJ <br />Addle= .2-y) 4 E. (..J E5E2 f-taavz ST7}cA4 TINJ 0..A 2.,() <br />LOCATION AND DATE OF DISCHARGE <br />Location: 34 E.. AL kJ <br /> <br />i2t pd•K) <br /> <br />(Best (Best Physical Desaiption) <br />Date of Discharge: U),--k‘6,,\Aurk.) <br />Date Notified: 4 - <br /> <br />• City* County) Circle One <br /> <br />Time: 0 N. eN.-) <br /> <br />D. RESPONSIBLE PERSON/BUSINESS <br />Name of Business: St-t-FIA_ OR_ _p Cz <br />Contact Person: Telephone: (SLO) k <br />Physical Address: <br />Mailing Address: PO 60,1- 402.3 i•Acoc2.7> <br />DESCRIPTION <br />Type of Discharge: <br />Volume: <br />Chemicals:n>6v 6 eklf\-11-7-J C--)t\5LL-1 A-/E <br />Circumstances: 6 A-r_zu C,D)../11MA it/r< -)KC,c) JC2.03 --)oR_IAJ( 2-aK2-ch714<--/ <br />(-)1:)G a-A-De c) 0)Li. 4. -edc11312-Li <br />ACTION TAN 6f Ls c4vE12-(/ 77Nit-(4 <br />fu A/ES C A/el ) Lane \ 4- z-4-'1,C,, <br />SITE DISPOSITION Si TE L.c)c&L__ fee_5610--1 <br />kN 1 - Fk--1-0\.) <br />Phone: ( ) <br />-.H 22 013 (Rev.4/91)